Fall/Winter 2007 - Stanford Hospital & Clinics

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2 S tanford ACCESS Fall/Winter 2007 The Pediatric and Adolescent Gynecology Program offers a range of services for the evaluation, diagnosis, and treatment of children and adolescents with gynecologic disorders including, but not limited to: Abnormal Bleeding • Frequent, irregular or heavy bleeding Adolescent Sexual Health and Contraception • Adolescents with complex medical problems who require contraception or hormonal therapy • New contraceptive options including implants and IUDs Breast Pathology • Asymmetry • Breast mass • Galactorrhea Congenital Genital Anomalies • Vaginal agenesis • Uterine and vaginal anomalies • External genitalia malformations • Imperforate hymen • Vaginal septa Genital Trauma • Traumatic injuries • Post assault injuries (after primary assault care completed) Menstrual Disorders • Primary and secondary amenorrhea • Oligomenorrhea • Dysmenorrhea Pelvic Masses • Ovarian cysts Pelvic Pain • Acute pelvic pain • Chronic pelvic pain • Endometriosis Reproductive Endocrinology • Hirsutism • Acne • Clitoromegaly • Polycystic ovary syndrome (PCOS) Vulvar, Vaginal and Cervical Lesions or Conditions • Vulvovaginitis • Lichen sclerosis • Condylomata/Genital warts • Abnormal pap smears • Bartholin’s gland cysts or abscesses • Vaginal foreign body Both Hillard and Lacy say they’ve learned that seemingly routine problems often require a closer look. “Even the most experienced adult gynecologist may not see many prepubertal girls, so when issues such as redness in the vulva occur, we can look beyond a yeast infection – often the cause in an adult but almost never the cause of irritation in a young girl – to find answers to questions we have addressed over and over again,” explains Hillard. “If a girl’s early menstrual periods are irregular or heavy, she will rarely complain. After all she has nothing directly to compare it to,” explains Hillard. “We need to ascertain whether the irregularity or heavy bleeding is within normal limits. In most cases, “it’s okay, she’s just a teenager,” is not the right answer. Lacy and Hillard note that the American College of Obstetrics and Gynecology recommends a visit (not necessarily a gynecologic exam) with a gynecologist while a girl is between the ages of 13 and 15, usually for preventive guidance. “Even if a young girl is perfectly comfortable with her lifelong pediatrician for most care, she may be quite uncomfortable telling that pediatrician that she is sexually active or asking why one breast is bigger than the other. In those instances, maybe we can help,” says Hillard. Working with parents and addressing concerns regarding confidentiality are part of the pantheon of psychosocial and psychosexual issues that the pediatric gynecologist confronts regularly. “Adolescent girls deserve privacy but you also don’t want to alienate the parent, who is legitimately concerned about the daughter’s health,” says Hillard. Hillard explains that often the daughter isn’t being as open about
S tanford ACCESS Fall/Winter 2007 Stanford’s Program for Pediatric and Adolescent Gynecology currently offers a comprehensive range of services, and works closely with Stanford Hospital & Clinics and Lucile Packard Children’s Hospital at Stanford to offer a full range of clinical specialists, subspecialties, and research protocols. sexual matters as the parent thinks she is. “When you talk to the daughter alone you find she already needs contraception and she’s at risk for STDs. She hasn’t told mom this, even though mom says, ‘My daughter tells me everything.’ This happens over and over again.” “At the first visit, we encourage the daughter to discuss her contraceptive needs with her mother. We need to help draw that mom into the care, set the stage for daughter to talk to mom, but meanwhile you don’t want the daughter to get pregnant. At that visit we may recommend birth control pills for menstrual cramps and irregular periods. We never leave out the family context, whether the family is a traditional mom or a statesponsored guardian,” Hillard says. Mothers also need to understand that their own experiences are not necessarily parallel to what their daughters are going through. Hillard said a study she and her colleagues did while she was at the University of Cincinnati revealed that mothers suffering from PMS would assume – consistently incorrectly – that their daughters were experiencing the same thing. Frequently the parent worries even before the daughter can possibly know what’s wrong. Lacy points to a 6-month-old infant’s mother who understandably was upset after an ultrasound revealed an incidental PAULA J. ADAMS HILLARD, MD Professor of Obstetrics and Gyencology Chief of the Division of Gynecologic Specialties finding that her daughter appeared to have a uterine anomaly. “In this case the finding transcended the limits of ultrasound technology and was not Paula Hillard obtained her medical degree from Stanford University School of Medicine and completed a residency in obstetrics and gynecology at the University of North Carolina, Chapel Hill. She then joined the faculty of the University of Virginia as Director of Ambulatory OB/GYN. Dr. Hillard was a member of the Department of OB/GYN at the University of Cincinnati from 1984-2007, and was the Director of Women’s Health for the University of Cincinnati College of Medicine. She has also served as Chief of Gynecology and Obstetrics at Cincinnati Children’s Hospital Medical Center, where she founded and directed the fellowship program in Pediatric and Adolescent Gynecology. She has been active on a number of national medical committees, including chair of the American College of Obstetricians and Gynecologists’ (ACOG) Committees on Patient Education, Adolescent Health, and Guidelines for Women’s Health. She is a past president of the North American Society for Pediatric and Adolescent Gynecology. She is an active contributor to the literature in adolescent gynecology and contraception with over 100 journal articles and abstracts published. She speaks frequently at national and international meetings and postgraduate courses on topics in ambulatory obstetrics and gynecology, pediatric and adolescent gynecology, cervical cancer screening, interpersonal violence, and primary care. Her clinical work has earned the designation as one of the “Best Doctors for Women” from Good Housekeeping Magazine. For consultation, Dr. Hillard can be reached at Paula.hillard@stanford.edu or (650) 725-5986. JUDITH A. LACY, MD Clinical Instructor Pediatric and Adolescent Gynecology Division of Gynecologic Specialties Department of Obstetrics and Gynecology After attending medical school at Oregon Health and Science University, Judith Lacy completed her OB/GYN residency at Duke University Medical Center. She then went on to complete a fellowship in pediatric and adolescent gynecology at the Hospital for Sick Children, affiliated with the University of Toronto. Dr. Lacy’s current interests include congenital anomalies of the female reproductive tract, ovarian preservation in adolescents and women undergoing chemotherapy, human papilloma virus and the HPV vaccine, polycystic ovarian syndrome, endometriosis in adolescents and adult women, management of menorrhagia in adolescents and adult women, and diagnosis and management of vulvovaginitis and vulvar dermatoses in the pediatric population. Judy can be reached at (650) 725-0601 or jalacy@stanford.edu for consultations with colleagues. 3
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Fall/Winter 2007 - Stanford Hospital & Clinics

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